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nnrl_ {a.~ <br />~,~~ 22/2990 13:99 3937722927~1.A7 E OI; (;ULUtLAllU ~ 'II'I"I"II""'I~ <br />s~',~ :• 1\tI\E .A!\D RECLA~IATIO\ BOA sss <br />D:,~ <br />PART1' STATUS REALEST FORA <br />In the matter of File No. M-~- QI S . Permit/Permit Amendment Application. <br />Name of Operator/Applicant and Site: WFSTttNN -+sewLr BauLD~t/2'NG w Sy1!!~p/ARJ <br />13r LAP-ttea~ CoR~. 1, ~,c P, ..+' ~ <br />_ I request [hat I be named as a party <br />_____ I request that I trot be named as a party <br />_~ I request to be withdrawn from parry status <br />I understand that if 1 am not a party, my statements of concern or objection to this <br />application will not be considered during the review of tht gpplicadon, but I may address <br />the Board on this matter at the final hearing, and may present my concerns as an <br />interested member of the public <br />For people who do not wish to become parties in this matter, information on permit <br />application status tan be requested from the Division of Minerals and Geology. <br />fKturiVt ~iRtCt'iR~ S*: /rt~~N t/wlJ.t~rGOA~~uN/Ty wRTLgDOGS <br />/~NARD E. CsAR4/LG. f L <br />printed Name Home Phone <br />5'f9~ Ny4.T [ ~eAD ( ~ <br />Address Work Phone <br />~,..a.J(iwio~lt L'Q }OSe3 L 1 <br />Ciry, State Zip Code FAX w <br />~GAR~tII ~ RoL, • Cers <br />E-Mail Address <br />Signature ~~- Date <br />if you are requesting to be named as a party, please briefly describe below: <br />I how you may be affetted or aggrieved by the Board's decision in the matter referenced above, <br />}'our opposition to the matter, including a specific description of the issues that you feel need <br />to be addressed at the final hearing. (You, may attach a written statement to this form instead <br />of using the space below.) <br /> <br /> <br />